Haloperidol
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Neuroleptic malignant syndrome and associated complications: case report A 36-year-old man developed neuroleptic malignant syndrome (NMS), altered mental status, rhabdomyolysis, decreased responsiveness, cardiomyopathy, autonomic dysfunction, agitation and paranoia during neuroleptic therapy with haloperidol [duration of treatment to reactions onsets not stated]. The man, who had a history of depression, anxiety and polysubstance abuse, presented with an altered mental status. He was hospitalised. He had been receiving haloperidol [route and dosage not stated]. He also had worsening agitation, for which he was initially given escalating doses of haloperidol. On hospitalisation day 4, he developed fever and showed increased creatine kinase levels indicating rhabdomyolysis. He became increasingly rigid and less responsive. Therefore, he was transferred to the ICU. He was considered to have NMS. Haloperidol was discontinued, and the man was treated with lorazepam. Despite an unspecified supportive treatment for rhabdomyolysis, his creatine kinase levels increased further. Therefore, he was treated with dantrolene. On hospitalisation day 6, he developed an episode of sinus bradycardia. Therefore, a transthoracic echocardiogram (TTE) was performed, which revealed decreased left ventricular ejection fraction (LVEF) to 33% with diffuse right ventricular hypokinesis. A cardiomyopathy with autonomic dysfunction in NMS was considered. His condition improved with medical management and dantrolene. Repeat TTE showed LVEF of 59% and normal right ventricular function. On hospitalisation day 14, for worsening agitation and paranoia, he was treated with electroconvulsive therapy. He continued to improve with supportive care and dantrolene. On hospitalisation day 28, he was discharged to rehabilitation. Author comment: "Neuroleptic malignant syndrome (NMS) is a rare, life-threatening condition due to dopamine blockade in the basal ganglia and hypothalamus from the use of neuroleptic agents. NMS is characterized by altered mental status (AMS), muscle rigidity, rhabdomyolysis, hyperthermia, and dysautonomia." "This case. . .is a unique example of cardiomyopathy as a manifestation of autonomic dysfunction in NMS." Xi A, et al. Treatment and complications of neuroleptic malignant syndrome. Critical Care Medicine 47 (Suppl. 1): 62 abstr. 160, No. 1, Jan 2019. Available from: URL: http://doi.org/10.1097/01.ccm.0000550915.79019.18 [abstract] 803432057 USA
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Reactions 9 Nov 2019 No. 1778
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